JP4172261B2 - Continuous blood purification device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a continuous blood purification device that assists or substitutes for organ functions of a living body by purifying blood taken out of a body from a blood vessel and supplying useful substances thereto.
[0002]
[Prior art]
Conventionally, hemodialysis and blood filtration have been performed in order to improve a serious condition such as a patient with renal failure or a patient with hyperhydration due to postoperative drug injection. Whether to use dialysis or filtration for the treatment of patients is determined and selected as appropriate by the clinician in consideration of the condition of each patient, and an alternative method of dialysis or filtration is adopted. However, in recent years, it has been recognized that so-called continuous blood purification therapy (CHDF), which combines dialysis and filtration, can minimize adverse effects on patients and is rapidly becoming popular. CHDF is a method that gradually returns the patient to normal over a long period of time because the balance of fluids of the patient changes suddenly and adversely affects the patient's condition if treatment with dialysis and filtration is performed in a short time. The dialysate is used at a flow rate as low as about one-tenth that of normal hemodialysis therapy.
[0003]
CHDF does not require special facilities such as hemodialysis and can be performed quickly at night or in an emergency, and it can be performed without trouble in the installation place even in a place surrounded by many devices such as operating rooms and ICU. Because it is possible, it can be said that blood purification therapy is available at any time and place. On the other hand, when managing critically ill patients, it is possible to quickly deal with troubles due to errors in dialysate flow rate and replacement fluid flow rate, and replacement of blood filters. Since doctors have to be on the bedside 24 hours a day so that they can respond, many facilities refrain from CHDF due to a lack of medical staff.
However, recently, a CHDF dedicated bedside console has been developed, and the accuracy of various monitors and flow rate adjustment mechanisms has been improved, so it is possible to prevent problems during the implementation of CHDF, and to improve the safety for patients and the burden on medical staff. There is a dramatic improvement in terms of mitigation.
[0004]
In such a continuous blood purification apparatus used for CHDF, a weight sensor is used as a means for measuring the amount of dialysate and the amount of replacement fluid entering and exiting the blood circulation path (consisting of a blood circuit and a blood purifier). There is a weight measurement method that uses a weighing container and a capacity measurement method that uses a weighing container.
However, although the accuracy of the flow rate adjustment mechanism has improved, in the gravimetric method, since the liquid weight is measured by separate weighing scales, there is an error between the dialysate flow rate and the replacement fluid flow rate due to variations in the weighing scales. Has drawbacks.
In addition, the capacity measurement method requires a measuring container for each liquid, and performs measurement while calibrating each roller pump (for example, Patent Document 1). Therefore, calibration is performed to eliminate variations between pumps. It is necessary to frequently perform calibration, and it is necessary to open and close the valve during calibration.
[0005]
[Patent Document 1]
JP-A-8-191889 (paragraph number 0014, lines 23-28, paragraph number 0016, lines 23-28)
[0006]
[Problems to be solved by the invention]
The present invention has been made in view of the above circumstances, and an object of the present invention is to provide a continuous blood purification apparatus in which an error between a dialysate flow rate and a replacement fluid flow rate is extremely small, and the number of pump calibrations is greatly improved. To do.
[0007]
In order to solve the above-mentioned problems, the present inventors, as a result of intensive studies, effectively combine the advantages of a weight measurement method with a small number of calibrations and a volume measurement method with a small error between the dialysate flow rate and the replacement fluid flow rate. The present invention has been completed. That is, the present invention includes a blood purifier, a blood circuit, a dialysate circuit, a dialysate container, and a replacement fluid container, and in a blood purification apparatus capable of continuously purifying blood, dialysis downstream of the blood purifier The liquid circuit is provided with a hermetically sealed solid container. The rigid container includes a flexible dialysate storage container that communicates with the dialysate container via the dialysate supply line, and a replacement fluid via the replacement fluid supply line. A flexible replacement fluid storage container communicating with the container is accommodated, and the dialysate pump provided in the dialysate supply line supplies the dialysate from the dialysate container to the dialysate storage container, and the dialysate storage The dialysate is supplied from the container to the blood purifier, the replacement fluid pump provided in the replacement fluid supply line supplies the replacement fluid from the replacement fluid container to the replacement fluid storage container, and the front from the replacement fluid storage container. Supply of replacement fluid to the downstream of the blood circuit of the blood purifier is made, along with the spent dialysate is supplied to the rigid container through the dialysate circuit downstream of the blood purifier in the dialysis circuit downstream, An on-off valve is provided between the blood purifier and the hard container, and a measuring line that can be opened and closed is provided between the on-off valve and the hard container, and is branched from the downstream dialysate circuit . The present invention relates to a continuous blood purification apparatus that can measure the amount of used dialysate discharged from the hard container by a weigh scale .
[0008]
Here, the dialysate supply line between the dialysate storage container and the dialysate pump, and the replacement fluid between the replacement fluid storage container and the replacement pump so that it can be detected when the container is empty or full. Each supply line is preferably provided with a pressure sensor for detecting the pressure in the container. Further, in the dialysis circuit downstream, between the blood purifier and the on-off valve branches from the dialysate circuit downstream, provided interposed the water removal line of the ultrafiltration pump, 該除water line The water removal amount may be measured by a weight meter provided in Further, a heater may be provided in the hard container so that the used dialysate flowing into the hard container can be heated. In the blood purification apparatus of the present invention, the spent dialysate stored in a hard container is drained in an amount equal to the amount of dialysate or replacement fluid supplied to the dialysate storage container or the replacement fluid storage container, respectively. The container is supplied with a used dialysate in an amount equal to the amount of dialysate or replacement fluid discharged from the dialysate storage container or the replacement fluid storage container, respectively. In the present invention, the term “used dialysate” refers to a liquid that flows into a hard container from a downstream dialysate circuit, and includes a filtrate and a cleaning liquid.
[0009]
DETAILED DESCRIPTION OF THE INVENTION
Next, embodiments of the present invention will be described with reference to the drawings.
FIG. 1 is a basic flow diagram of the continuous blood purification apparatus of the present invention. FIGS. 2 to 4 are flow charts of continuous hemodialysis and continuous blood filtration performed using the continuous blood purification apparatus of the present invention, respectively. It is a flow figure and a flow figure of continuous hemofiltration dialysis.
As shown in FIG. 1, the continuous blood purification apparatus of the present invention includes a blood purification device 1, blood circuits 21 and 22, dialysate circuits 35 and 36, a dialysate container 3, and a replacement fluid container 4. The dialysate circuit 36 downstream of the vessel 1 is provided with a sealed solid container 5. The rigid container 5 (hereinafter referred to as a tank) communicates with a flexible dialysate storage container 34 that communicates with the dialysate container 3 through a dialysate supply line 31 and with the replacement fluid container 4 through a replacement fluid supply line 41. A flexible replacement fluid storage container 44 is accommodated, dialysate is supplied to the dialysate storage container 34 and the blood purifier 1 by the dialysate pump 32, and the replacement fluid storage container 44 and the blood purifier 1 are supplied by the replacement fluid pump 42. The replacement fluid is supplied to the downstream blood circuit 22.
[0010]
In FIG. 1, the blood circulation path includes a blood passage of the blood purifier 1, an upstream blood circuit 21 and a downstream blood circuit 22, and the upstream and downstream blood circuits 21, 22 have blood pumps 23, respectively. And the on-off valve V1 is provided.
On the other hand, the dialysate flow path includes a dialysate supply line 31 that connects the dialysate container 3 and the dialysate reservoir 34, a dialysate circuit 35 on the upstream side, a dialysate passage of the blood purifier 1, and a dialysate on the downstream side. The downstream dialysate circuit 36 is connected to a sealed solid container (tank) 5. The tank 5 contains a dialysate storage container 34 and a replacement fluid storage container 44. The dialysate supply line 31 is provided with an on-off valve V 2, a dialysate pump 32, and a pressure sensor 33 in order from the upstream side, and the upstream dialysate circuit 35 has a dialysis between the on-off valve V 2 and the dialysate pump 32. The liquid supply line 31 is connected. The upstream dialysate circuit 35 and the downstream dialysate circuit 36 are provided with on-off valves V3 and V4, respectively.
The replacement fluid flow path includes a replacement fluid supply line 41 that connects the replacement fluid container 4 and the replacement fluid storage container 44 and a replacement fluid line 45 that connects the replacement fluid storage container 44 and the blood circuit 22 on the downstream side. An on-off valve V5, a replacement fluid pump 42, and a pressure sensor 43 are provided in order from the upstream side, and an on-off valve V6 is provided in the replacement fluid line 45.
In the downstream dialysate circuit 36, a dewatering line 7 is connected between the blood purifier 1 and the on-off valve V4, and a metering line 8 is connected between the on-off valve V4 and the tank 5. The dewatering line 7 is provided with a dewatering pump 72 and a weigh scale 71 for measuring the dewatering amount. The measuring line 8 includes an on-off valve V7, a dialysate storage container 34, and a replacement fluid storage container. A weigh scale 81 for measuring the amount of dialysate and replacement fluid supplied to 44 is provided.
The pressure sensors 33 and 43 measure the internal pressures of the dialysate storage container 34 and the replacement fluid storage container 44, respectively. When a sudden increase in internal pressure is detected, the pumps 32 and 42 are stopped, and the on-off valves V2 and V5 are closed. When a sudden decrease in internal pressure is detected, the pumps 32 and 42 are stopped to prevent idling. In addition, as the on-off valves V1 to V7, an electric type is usually used.
[0011]
The tank 5 is preferably a hermetically sealed container made of a metal having good thermal conductivity, such as stainless steel or copper, and a flexible container made of plastic such as polyethylene or polypropylene, for storing dialysate therein. A container 34 and a replacement fluid storage container 44 are accommodated. Therefore, in a state where the tank 5 is filled with the used dialysate, the on-off valve V7 is opened to reduce the amount of dialysate supplied to the dialysate storage container 34 or the amount of replacement fluid supplied to the replacement fluid storage container 44. This can be confirmed by measuring the used dialysate discharged through the measuring line 8. When the tank 5 is made of a metal having good thermal conductivity, the used dialysate stored in the tank 5 is heated by providing a heater 6 outside, and the used dialysate is heated. Thus, the dialysate in the dialysate storage container 34 and the replacement fluid in the replacement fluid storage container 44 can be heated. Further, when the tank 5 is formed of a material having poor thermal conductivity such as plastic, the dialysate or the replacement fluid is heated by providing a heating means (not shown) in the downstream dialysate line 36. Can do.
[0012]
Next, the use of the continuous blood purification apparatus of the present invention will be described.
When continuous hemodialysis is performed using the continuous blood purification apparatus of the present invention, the CH D flow diagram shown in FIG. 2 is followed.
When the tank 5 is filled with spent dialysate, the dialysate reservoir 34 is empty, and the on-off valves V2 and V7 are opened with the on-off valves V1 to V7 closed, the dialysate pump 32 is driven. The dialysate is supplied from the dialysate container 3 to the dialysate storage container 34 through the dialysate supply line 31, while the same amount of spent dialysate in the tank 5 is supplied to the downstream dialysate circuit 36 and metering. It is discharged to the outside through the line 8. Therefore, at this time, if the amount of the used dialysate discharged is measured by the weight meter 81, the amount of dialysate per unit time supplied to the dialysate storage container 34 by the dialysate pump 32 can be known. The dialysate pump 32 can be calibrated by comparing with the flow rate. When the dialysate reservoir 34 is full, the pressure sensor 33 detects a sudden increase in internal pressure, receives the internal pressure rapid increase signal, stops the dialysate pump 32, and closes the on-off valve V2.
[0013]
Next, the on-off valve V1 is opened, the blood pump 23 is driven to circulate blood in the blood circulation path, the on-off valve V7 is closed, the on-off valves V3, V4 are opened, and the dialysate pump 32 is reversely driven ( When the dialysate is rotated in the reverse direction from when the dialysate storage container 34 is supplied, the dialysate in the dialysate storage container 34 is supplied to the blood purifier 1 through the dialysate circuit 35 on the upstream side. After being performed, it is supplied to the tank 5 through the dialysate circuit 36 on the downstream side. At this time, if necessary, the water removal pump 72 may be driven to perform water removal. The water in the removed blood is discharged through the water removal line 7 and is weighed by the weigh scale 71. When the dialysate storage container 34 becomes empty, the negative pressure is detected by the pressure sensor 33, the negative pressure signal is received, the dialysate pump 32 is stopped, and the on-off valves V3 and V4 are closed. Thereafter, the same operation may be repeated.
[0014]
When performing continuous blood filtration, follow the CHF flow diagram shown in FIG.
When the tank 5 is filled with spent dialysate, the replacement fluid storage container 44 is empty, and the on-off valves V1 and V7 are closed, the on-off valves V5 and V7 are opened and the replacement fluid pump 42 is driven. While the replacement fluid is supplied from the container 4 to the replacement fluid storage container 44 through the replacement fluid supply line 41, the same amount of spent dialysate in the tank 5 passes through the downstream dialysate circuit 36 and the measuring line 8 to the outside. To be discharged. Therefore, at this time, if the amount of the used dialysate discharged is measured by the weigh scale 81, the amount of the replacement fluid per unit time supplied to the replacement fluid storage container 44 by the replacement fluid pump 42 can be known. By doing so, calibration of the replacement fluid pump 42 can be performed. When the replacement fluid storage container 44 becomes full, the pressure sensor 43 detects a sudden increase in internal pressure, receives the internal pressure rapid increase signal, stops the replacement fluid pump 42, and closes the on-off valve V5.
[0015]
Next, the on-off valve V1 is opened, the blood pump 23 is driven to circulate blood in the blood circulation path, the on-off valve V7 is closed, the on-off valves V4, V6 are opened, and the replacement fluid pump 42 is reversely driven (replacement fluid) , The replacement fluid in the replacement fluid storage container 44 is supplied to the downstream blood circuit 22 through the upstream replacement fluid circuit 45. At this time, if necessary, the water removal pump 72 may be driven to perform water removal. The water in the removed blood is discharged through the water removal line 7 and is weighed by the weigh scale 71. When the replacement fluid storage container 44 becomes empty, the negative pressure is detected by the pressure sensor 43, the negative pressure signal is received, the replacement fluid pump 42 is stopped, and the on-off valve V6 is closed. Thereafter, the same operation may be repeated.
[0016]
When performing continuous hemofiltration dialysis, the CHDF flow diagram shown in FIG. 4 is followed.
The tank 5 is filled with spent dialysate, the dialysate reservoir 34 and the replacement fluid reservoir 44 are empty, and the on-off valves V2 and V7 are opened with the on-off valves V1 to V7 closed, and the dialysate pump When 32 is driven, the dialysate is supplied from the dialysate container 3 to the dialysate storage container 34 through the dialysate supply line 31, while the same amount of spent dialysate in the tank 5 is supplied to the downstream dialysate. The liquid is discharged outside through the liquid circuit 36 and the metering line 8. Therefore, at this time, if the amount of the used dialysate discharged is measured by the weight meter 81, the amount of dialysate per unit time supplied to the dialysate storage container 34 by the dialysate pump 32 can be known. The dialysate pump 32 can be calibrated by comparing with the flow rate. When the dialysate reservoir 34 is full, the pressure sensor 33 detects a sudden increase in internal pressure, receives the internal pressure rapid increase signal, stops the dialysate pump 32, and closes the on-off valve V2.
[0017]
Next, when the on-off valve V5 is opened and the replacement fluid pump 42 is driven, the replacement fluid is supplied from the replacement fluid container 4 to the replacement fluid storage container 44 through the replacement fluid supply line 41, while the same amount of spent dialysis in the tank 5 is used. The liquid is discharged to the outside through the downstream dialysate circuit 36 and the metering line 8. Therefore, at this time, if the amount of the used dialysate discharged is measured by the weigh scale 81, the amount of the replacement fluid per unit time supplied to the replacement fluid storage container 44 by the replacement fluid pump 42 can be known. By doing so, calibration of the replacement fluid pump 42 can be performed. When the replacement fluid storage container 44 becomes full, the pressure sensor 43 detects a sudden increase in internal pressure, receives the internal pressure rapid increase signal, stops the replacement fluid pump 42, and closes the on-off valve V5.
[0018]
Next, the on-off valve V1 is opened and the blood pump 23 is driven to circulate blood in the blood circulation path, the on-off valve V7 is closed, the on-off valves V3 and V4 are opened, and the dialysate pump 32 is reversely driven. Then, the dialysate in the dialysate storage container 34 is supplied to the blood purifier 1 through the upstream dialysate circuit 35, and after hemodialysis, is supplied to the tank 5 through the downstream dialysate circuit 36. Supplied. At this time, if necessary, the water removal pump 72 may be driven to perform water removal. When performing water removal, you may perform a replacement | exchange liquid simultaneously as needed. The water in the removed blood is discharged through the water removal line 7 and is weighed by the weigh scale 71. When performing the replacement fluid, the on-off valve V6 is opened and the replacement fluid pump 42 is driven in reverse. At this time, the replacement fluid in the replacement fluid storage container 44 is supplied to the downstream blood circuit 22 through the upstream replacement fluid circuit 45. When the replacement fluid storage container 44 becomes empty, the negative pressure is detected by the pressure sensor 43, the negative pressure signal is received, the replacement fluid pump 42 is stopped, and the on-off valve V6 is closed. When the dialysate storage container 34 becomes empty, the negative pressure is detected by the pressure sensor 33, the negative pressure signal is received, the dialysate pump 32 is stopped, and the on-off valves V3 and V4 are closed. Thereafter, the same operation may be repeated.
[0019]
【The invention's effect】
As is clear from the above description, the continuous blood purification apparatus of the present invention effectively takes advantage of the weight measurement method with a small number of calibrations and the volume measurement method with a small error between the dialysate flow rate and the replacement fluid flow rate. Since they are combined, the error of the dialysate flow rate and the replacement fluid flow rate can be extremely reduced in the continuous blood purification therapy by employing the present invention. In addition, the number of pump calibrations can be greatly reduced.
[Brief description of the drawings]
FIG. 1 is a basic flow diagram of a continuous blood purification apparatus of the present invention.
FIG. 2 is a flow diagram of continuous hemodialysis performed using the continuous blood purification apparatus of the present invention.
FIG. 3 is a flow chart of continuous blood filtration performed using the continuous blood purification apparatus of the present invention.
FIG. 4 is a flow diagram of continuous hemofiltration dialysis performed using the continuous blood purification apparatus of the present invention.
[Explanation of symbols]
1 Blood Purifier 21 Upstream Blood Circuit 22 Downstream Blood Circuit 23 Blood Pump 3 Dialysate Container 31 Dialysate Supply Line 32 Dialysate Pump 33 Pressure Sensor 34 Dialysate Storage Container 35 Upstream Dialysate Circuit 36 Downstream Dialysate circuit 4 Replacement fluid container 41 Replacement fluid supply line 42 Replacement fluid pump 43 Pressure sensor 44 Replacement fluid storage container 45 Replacement fluid line 5 Tank (solid container)
6 Heater 7 Water removal line 71 Weigh scale 72 Water removal pump 8 Drain line 81 Weigh scale V1 to V7 Open / close valve

Claims (5)

In a blood purification apparatus that comprises a blood purifier and a blood circuit, a dialysate circuit, a dialysate container, and a replacement fluid container and can purify blood continuously, the dialysate circuit downstream of the blood purifier includes: A sealed hard container is provided, and the hard container includes a flexible dialysate storage container that communicates with the dialysate container via the dialysate supply line, and a flexible fluid that communicates with the replacement fluid container via the replacement fluid supply line. A dialysis fluid supply line from the dialysis fluid container to the dialysis fluid storage container, and a blood purifier from the dialysis fluid storage container. The dialysate is supplied to the replacement fluid supply line, and the replacement fluid pump provided in the replacement fluid supply line supplies the replacement fluid from the replacement fluid container to the replacement fluid storage container, and the blood downstream of the blood purifier from the replacement fluid storage container. Made the supply of replacement fluid to the circuit, along with the spent dialysate is supplied to the rigid container through the dialysate circuit downstream of the blood purifier,
In the downstream dialysis circuit, an open / close valve is provided between the blood purifier and the hard container, and a branching line is opened between the open / close valve and the hard container from the downstream dialysate circuit to provide an openable and closable measuring line. provided, the weight meter provided in the metering line, formed by the amount of used dialysate which is discharged from the rigid container to be measured continuous blood purification apparatus.   The dialysate supply line between the dialysate storage container and the dialysate pump and the replacement fluid supply line between the replacement fluid storage container and the replacement fluid pump are each provided with a pressure sensor for detecting the pressure in the container. Blood purification device. In dialysis circuit downstream, between the blood purifier and the on-off valve branches from the dialysate circuit downstream, it provided interposed the water removal line of the ultrafiltration pump, provided in該除water line The blood purification apparatus according to claim 1 or 2, wherein the water removal amount can be measured by a weigh scale .   The blood purification apparatus according to any one of claims 1 to 3, wherein a heater is provided in a hard container so that the used dialysate flowing into the hard container can be heated.   The spent dialysate stored in the hard container is drained in an amount equal to the amount of dialysate or replacement liquid supplied to the dialysate storage container or the replacement fluid storage container, respectively, and in the hard container, The blood according to any one of claims 1 to 4, wherein a used dialysate is supplied in an amount equal to the amount of dialysate or replacement fluid discharged from the dialysate storage container or the replacement fluid storage container, respectively. Purification equipment.

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